Provider Demographics
NPI:1487067773
Name:LISA S SPLITTSTOESSER MD INC
Entity type:Organization
Organization Name:LISA S SPLITTSTOESSER MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:S
Authorized Official - Last Name:SPLITTSTOESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:808-822-4844
Mailing Address - Street 1:4-1558 KUHIO HWY
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1856
Mailing Address - Country:US
Mailing Address - Phone:808-822-4844
Mailing Address - Fax:808-821-2922
Practice Address - Street 1:4-1558 KUHIO HWY
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1856
Practice Address - Country:US
Practice Address - Phone:808-822-4844
Practice Address - Fax:808-821-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD11865207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH72135Medicare UPIN